- I have atrial fibrillation and have been taking warafin to prevent blood clots. I've heard there may be a drug alternative that doesn't require regular blood checks.
- Is dark chocolate good for you?
- When is a good time to start thinking about my heart health?
- I recently had a cardiac ultrasound because I was short of breath. Should I be concerned?
Q. I have atrial fibrillation, and for many years have been taking warfarin to prevent blood clots. I have recently heard that there may be a drug alternative that doesn't require regular blood checks.
Atrial fibrillation is a common irregularity of the heart rhythm. If the left atrium doesn't vigorously empty its blood, a blood clot may form there, or next to it in the left atrial appendage, with the possibility of a stroke.
It is more likely to occur with old age, and in association with some other heart conditions.
Depending on a variety of factors, your doctor usually chooses to reduce the risk with aspirin or warfarin. Those who take warfarin need a regular blood test to see that the dose is within a safe and effective range. The effect can be altered by a variety of dietary and medication factors, including by some herbal supplements.
Recent studies have compared warfarin with a new twice-a-day tablet, called dabigatran (the trade name is Pradaxa). It doesn't require regular blood test monitoring.
Although Pradaxa is not yet available in Australia for treatment of atrial fibrillation, the study's results are very encouraging – it reduced stroke rate to the same extent as warfarin, and with less bleeding side effects.
While this is very promising, doctors have more experience with warfarin. Also, Pradaxa is more expensive and will have its own challenges, including drug interactions and side effects.
My suggestion would be that since you have been doing well with the warfarin, you should continue as you are. Just be aware that this new medication may soon be available as an alternative for people being newly considered for warfarin for atrial fibrillation. It is currently a treatment option to prevent deep vein thrombosis after hip or knee surgery.
Q. Is dark chocolate good for you?
Since chocolate is a common additive to food, and heart disease is so prevalent in our society, it is inevitable that the association has been studied.
Researchers have shown that cocoa contains a subgroup of flavenoids called flavenols which can help in endothelial function (blood vessel lining) and blood flow in several ways, including the release of nitric oxide.
The cocoa flavenols also have beneficial antioxidant effects and reduce tendency for blood platelets to clot. Chocolate also contains phenylethylamine which releases endorphins in the brain and can elevate mood.
While all cocoa is rich in flavenols, the particular processing of the bitter tasting flavenols into cocoa powder or confectionary chocolate determines the flavenol content of then final product - not the final colour of the chocolate. Nonetheless, dark chocolate tends to have the highest cocoa content, suggesting this may be the one to choose.
However, even if dark chocolate may be good for the heart, its calorie content (e.g 480 calories per 100-gram bar, means that weight gain may offset any potential benefit). Also, bear in mind that other foods such as tea, red wine apples, vegetables and grains are also high in flavenols.
Final proof of benefit from dark chocolate will require a large randomised study, for which there will probably be many volunteers. This topic is best summarised by a quote from my grandmother (and probably yours) of 'everything in moderation', and finally – Mum: 'Fred, there were two chocolate cakes in the pantry yesterday, and now there's only one. Why?'
Fred: 'I don't know. It must have been dark so I didn't see the other one.'
Q. When is a good time to start thinking about my heart health?
For everyone, 'now' is the best time to start thinking about improving your heart health. The first goal is to prevent heart disease before it has become evident, and the second is to prevent any further problems, such as a heart attack after a stent is placed in a narrowed artery.
Even if atherosclerosis or artery narrowing remains present, there is ample evidence that lowering cholesterol and blood pressure, by lessening the tendency for blood clotting, can help reduce the chance of a heart attack. A marked reduction in cholesterol has been shown to even reverse the severity of atherosclerosis, and the risk for smokers who quit, immediately lessens.
Additionally, it is recognised that early changes of atherosclerosis begin in some children by the age of ten. Steps to prevent the development of risk factors such as high blood pressure and cholesterol are important, even in the young. As we all know, obesity in children as well as adults is a major problem, pointing to the need for daily fun physical exercise, less time in front of the TV or computer, avoiding exposure to second-hand cigarette smoke, and healthy food habits.
Q. I recently had a cardiac ultrasound because I was short of breath. My doctor said the ultrasound was normal, but the report said I had ‘trivial mitral regurgitation'. Should I be concerned?
It is quite common for small leaks (regurgitation) to occur through a heart valve, such that when the valve opens and shuts, it doesn't fully seal. Although valves are very impressive in their general function and reliability, they are not machine-made. Fortunately, in contrast to severe forms, trivial regurgitation will not cause any extra strain on the heart, and is most unlikely to get worse.
The ultrasound, which is a very useful test, can look closely at the appearance of the valves as well as heart function, and the doctor's assessment is reassuring. However, the ultrasound is just one test, and the doctor will need to factor that into the assessment of why you are short of breath.
Disclaimer: While due care is taken in the preparation of these questions and answers, the information contained on this website is not intended as specific medical advice, and should be used as a guide only. Consult your doctor or healthcare professional before following any advice.
